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Background: Prophylactic cranial irradiation (PCI) remains the standard of care in patients who respond to first-line chemotherapy for ES-SCLC, although several recent studies have questioned its benefit with regard to survival.

Methods: To see whether PCI was associated with improved survival in ES-SCLC patients, we conducted a retrospective study at a regional cancer centre in New Zealand. All ES-SCLC patients who had at least one cycle of chemotherapy from 2001 through April 2017 were included. The available medical records were reviewed to extract clinical variables: age, sex, comorbidities, metastatic sites, chemotherapy [regimen, and number of chemotherapy lines (NCL)], radiotherapy [palliative, consolidation chest radiotherapy (CCRT), or PCI], and overall survival (OS). Univariate analysis stratified by PCI status (received vs. not received) was performed. Stepwise Cox's regression was used to identify and adjust for confounders that affect survival by PCI status. The subgroups were examined by Kaplan-Meier method.

Results: 327 ES-SCLC patients who received ≥1 cycle of chemotherapy were identified; of the 245 patients with available records, median OS was 7.7 months (95% CI: 5.7–8.6 months). In 49 patients (20%) who received PCI, the median OS was 14.3 months (95% CI: 11.5–17.4), compared to 6.3 months (95% CI: 5.2–7.3) in patients who did not receive PCI (unadjusted hazard ratio (HR) for death: 0.34, 95% CI: 0.24–0.48). After adjusting for three covariates (NCL, whether ≥4 cycles of first-line chemotherapy was given, and whether CCRT was delivered), however, difference in survival was no longer significant (adjusted HR: 0.66, 95% CI: 0.42–1.04). No difference was observed in OS among subgroups. 85 patients (35%) who had <4 cycles of first-line chemotherapy (and did not receive more chemotherapy) had a dismal prognosis (median OS: 2.9 months, 95% CI: 1.8–3.4).

Conclusions: Though ES-SCLC patients treated with PCI appear to have a better survival, but this positive association is not independent of treatment characteristics. Without further data from randomised trials, PCI should be used judiciously considering its toxicities and detriments to quality of life.

Clinical trial identification:

Legal entity responsible for the study: Waikato District Health Board

Funding: Has not received any funding

Disclosure: All authors have declared no conflicts of interest.

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